Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion in girls and adolescents

Abstract

Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion to the improvement of early diagnosis and development of optimal ways of organ-preserving surgical tactics of treatment have been determined. An analysis was carried out of 71 patients with adnexal torsion (group 1– 30 girls of 2–12 years, group 2 – 41 adolescents of 13–17 years). The main clinical signs of adnexal torsion were nonspecific and similar to the well-known clinic of acute abdomen. Ultrasound examination with color doppler mapping (CDM) allowed to suspect adnexal torsion in 44 (62 %) patients. The main echographic features of adnexal torsion were: ovarian enlargement, non-typical location and a change in the structure of ovary, the presence of a free liquid in the cavity of a small pelvis or in the abdominal cavity, «a symptom of springs» (a twisted vascular leg), a decrease or absence of blood flow in CDM. The torsion of intact uterine appendages is installed in 29 patients (twice as often in group 1). In 42 cases were detected the torsion of the uterine appendages, compromised by the presence of tumors and tumor-like formations (twice as often in group 2). In both groups, 36 (50.7 %) organ-preserving and 35 (49.3 %) radical operations were carried out. According to the results of morphological examination of the removed tissues, the following data were obtained: follicular cysts – 15, paratubal cysts – 8, corpus luteum cysts – 8, teratomas – 5, serous cystadenomas – 2, mucinous cystadenoma – 1, paraovarian cysts – 3. Differential diagnosis of adnexal torsion in girls and adolescents should include a thorough collection of anamnestic data, taking into account the features of the clinical course of the disease, the results of a comprehensive examination with an assessment of ultrasound data from CDM, computer and magnetic resonance imaging, which will contribute to the advanced adequate selection of tactics of urgent gynecological intervention. The method of choice for the treatment of adnexal torsion is a minimally invasive surgical intervention – a laparoscopy with organ-preserving operations. Keywords: adnexal torsion, girls, ultrasound and morphological characteristics.